HomeMy WebLinkAbout0070 CENTER STREET - HAZMAT L� A
enter Street ��,EwEtR
is7— 154
i
0
a
YOU WISH TO OPEN A BUSINESS?
T.-. I I
'7- h" I j.. .f '' ? . J .E. .. 7 ,!,i<o :I' .... !� ,f,i r• +( (1 -,i:l! ..J_ -i r r ..j; ' .n. it 'p. t'i'•
.. , � - _. 5 .. ;,C. rC.;•, r r ) :. I t .... � I L., .:. .r r \ r)_ `:.; :'iV t i,.: -;Ct .. ! - .
DATE: �� �Zc '( � Fill in please:
APPLICANT'S YOUR NAME/S: a 00\xyi I—A T L
1 .. BUqINPq YOUR HOME ADDRESS: ,o ta.( L—AVt- r?—&
ELE HONE #. Home Telephone Number 'i-U
NAME OF CORPORATION:
NAME.OF NEW BUSINESS PE OF BUSINESS ' - harap
IS THIS A HOME OCCUPATIO ? YF-S NO ✓. 2r� �/ 1�
ADDRESS OF BUSINESS MAP/PARCEL NUMBER✓Z T—�5 —DOD (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form.is intended to assist you in obtaining the information you may need. You MUST G0'r).200 MF, r, ;'c}. (..;,
..:F M77f?"`itrC't't tE� '3i 1{ti _ (7Ei ��.,? T.: thE } Ili t7�1_`In}:t � r>j""lt6 t[ti IIrE:n`', - =-!1 it �. to !eaally cpff i;.r:?t.Es your bti ii' "iS [:Cwl"..
r
1. BUILDING COMMISSIONER'S OFFICE .
.This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature
COMMENTS:
2. BOARD OF HEALTH
This individual has een rmed'o the permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSNG AUTHORITY)
This individual has Fn inf r e f he licensing requirements that Pertain to this type of business. '
Authorized Signature"
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
req u i red by law.
DATE: �'/_ �� Fill in please:
-11 APPLICANT'S YOUR NAME/S:
' USINE S YOUR HOME ADDRESS: 6 u
W.
P
aw=- TELEPHONE # Home Telephone Number 5"1,!pZ//Z O;ZG-3
NAME OECORPORATION:
NAME OF NEW BUSINESS.. -TYPE.OF BUSINESS
IS THIS.A HOME OCCUPATION?�( YES'; NO
ADDRESS OF BUSINESS 45, G� MAP/PARCEL NUMBER D (Assessing):'
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ER'S OFFICE UST COMPLY WITH HOME OCCUPATION
This indivi al hb a n'Infa of ny ermit req irements that pertain to this type of busine LES AND REGULATIONS. FAILURE TO
A thori . S. - re** COMPLY MAY RESULT IN FINES.
0MMENTS
/
2. BOARD OF ALTH V��-�01- E� S
This individual ha n inf me f e p r it req ' rfients that pertain to this type of business.
Authorized i ature** Must,COMPLY VyIT'H ALL
COMMENTS: K- 4ZA!92V8 MAT
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
04/21/2010 10:1/4rFAX 508 790 6325 WATER POLLUTION CONTROL Z 001
TOWN OF BARNSTABLE PEilr#
DEPARTMENT OF PUBLIC WORKS
SEWER CONNECTION COMPLIANCE
✓• i i
TELEPHONE:
INSTALLER
TELEPHONE: I:
PROPERTY OWNER: /
6 C 7 VILLAGE: �s
PROPERTY LOCATION: (� �� P✓ _
pipe Length:
Pi Diamcter_ -r
PARCEL �
ASSESSORS MAP 3of L
en done in conformance with he Rules and Regulations of the Department of Public Works.
The work h ..
Signumm-
Dcp nt Public"
flap t parcel f
527 - 154
34 i
5toryLand Golf
% disconnecteod5 f
j
Flay 18
ew�auw
I, 70 Center Street
i
68 Center street
` Hyannis
\JA• rY�M1e\ Jt
� r
�M1 \ yl pole
� alotlra r r- -'
j w polo
I
I
I SEWCOMPLXLS
Iazardo s aterials Inventory Sheet Checklist
01$te
' Physical Street Address-Check database to ensure it exists
Working Phone Phone Number
Actual.Amounts -( ie. gas being used to fuel machines,thinner to
clean brushes all count as hazardous materials-no blanks)
Storage Information -location of storage, how long is storage for?
If none, note that.
Disposal Information .where and who? If none, note that.
Applicant.Signature -understand what is listed and noted
----'`Staff Initial -any questions, know who to ask
Vehicle'Washing/Rinsing? =give a vehicle washing policy and
explain it
Attach the Business Certificate with your sign off and comments
**The inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
1
,ti
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town
(WHICH YOU MUST DO BY M.G.L. - it does. not give you permission to operate). You must first obtain the necessary signatures on this form
at 200 Main St.; Hyannis. Take the completed form to the Town Clerk's Office, 151 FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
DATE: tZ2ZZ�J
Fill in please: ^�
APPLICANT'S YOUR NAME: !/ /mil
r• s BUSINESS YOUR HOME ADDRESS:
a
TELEPHONE # Home Telephone Number: 5-3 — 9 12
NAME OF NEW BUSINESS/VIc+X Ualau jHS{/uC.frOh 2vUi TYPE OF BUSINESS cap
IS THIS A HOME OCCUPATION? YES NO
Have you been given approval from the building division? YES NO
ADDRESS OF BUSINESS .�� 6w4er 51. e4i ✓/7V060/5 MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable.
e This form is intended to assist you in obtaining the .information you may need. You MUST GO TO 200 Main St.'— (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this-
town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
2. BOARD OF HEALTH
This individual hakbee formed�efthe p requirements that pertain to this type of business. ` ' MUST COMPLY WITH ALL
Cam/(( HAZARDOUS MATERIALS REGULATIONiq
Authorized Signature"
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY
This individual ha Mn n infor ed of the 17 si gp�e rements that pertain to this type of business.
Au orized Signature"
. COMMENTS:
Date: Y4/2-2/
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS. max Va ��,,,f C°``'�'�'"u�}o� vi,�
BUSINESS LOCATION: b� '�� �� a41 . ya h'L t, `OEMOZ60/ INVENTORY
MAILING ADDRESS: C,V-_P- TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: MAX
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: CCLr4& 4,7 1'y �✓e�G. i`S
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous_waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED ,
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers & cleaning fluids
(dry cleaners) t
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS
y FORM30 C,w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE TH
CITY/TOWN
R.
W
DE ARTMENT
ADDRESS
G,M 5 0yW
TELEPHONE
Address k3� � Occupan
Floor Apartment No. No.of Occupants
No. of Habitable Rooms No.Sleeping Rooms '
No. dwelling or rooming units--No. rie
Name and address of owner
e arks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. —Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows: }�
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,S ties:
Kitchen Facilities Si k 0
e
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATION CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE-CODE OR'THE
AUTHORIZED INSPECTO See Over)
"THIS INSPECTION RE OR IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PER
INSPECTOR TITLE
DATE TIME P.M.
L
THE NEXT SCHEDU �'.IEINSPECTIONI P.M.
1
Al
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health,or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violat°on(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whore the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A),410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness wh.cl- may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire,burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain incorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or I-eating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents,cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
�� z �� ��
� �'��U�� � �:
�� �.����S�-� a�� � i
�I
�?
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and'get the Business Certificate that is
required by law.
# jiA
j� — DATE: — Fill in please:135-A /
, t APPLICANT'S YOUR NAME/S: - (J
M1r ' ` BUSINESS YO R H ME DDR
TELEPHONE # Home Telephone umber
NAIVItIbF CO
NAM RPORATION :' "
E OF NEW BUSINESS =' TYPE OF BUSINESS..
IS THIS A HOME OCCUPATION_ YES NO
AODRESS OF BUSINESS = MAP/PARCEL NUMBER �. h .` [Assessi.ng) ,
d/
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information.you may need. You MUST GO TO 200 Main St. -(corner of Yarmouth .
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COM ISs�, e
ER'S OF
This ihdivid al h infora pe mit requir merits that pertain to this type of business.
��
ut orize Sign at r
COMMENTS:
2. BOARD OF HEALTH
This individual has be i formed of t Admit r Oirements thapertain to this type of business.
horized Signature
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that,pertain to this type of business.
Authorized Signature*
COMMENTS:
TOWN OF BARNSTABLE Date:
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: OC-� � -5S
BUSINESS LOCATION: 70 � � INVENTORY
MAILING ADDRESS: 7o C&�%�� 57- UNl� 3 / (/NlS TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: V CL_;_&-YLW fA)S/L�
EMERGENCY CONTACT TELEPHONE NUMBER: 30g- 90 /-- L52 / MSDS ON SITE?
TYPE OF BUSINESS: �—
INFORMATION/RECOMMENDATIONS: Fire District:
e �n!
t S -- a,,a� da--
Waste Transportation: t A Last shipment of hazardous waste: N/�
Name of Hauler- W Destination: X) A
Waste Product: 1' Licensed? Yes No KiIA-
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) __ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
I Lacquer thinners - (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic zardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
^� Date
Physical Street Address-Check database to ensure it exists
Working Phone Number
Actual Amounts -( ie. gas being used to fuel machines, thinner to
clean brushes all count as hazardous materials-no blanks)
Storage Information -location of storage, how long is storage for?
If none, note that. —
/t/ Disposal Information -where and who? If none, note that.
/r Applicant Signature -understand what is listed and noted
_=k ,,; Staff Initial -any questions, know who to ask
Vehicle Washing/Rinsing? -give a vehicle washing policy and
explain it
®� Attach the Business Certificate with your sign off and comments
**The inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE: �r-) Fill in please:
APPLICANT'S YOUR NAME/S:
d''s�itli E ADDRESS: Q f it7 ii(u��><t�i�° i� °Ft BUSINESS YOUR HOM
1 �C,0
�' . 1 y Pad�r'I'FPi I, kk /, Y1� (SE
T 4c, ) -
. i l:`IP�:
'(F��'�.'ai 'vii: TELEPHONE # Home Telephone Number '57 E S -
S" 1�Nktll, il.'a 3�1
11 1 Ml �.Y Wm
NAME OF CORPORATION: Wafbo 4,e &n YXI 0 eAu)C C_e- SS 0P-"f
NAME OF NEW BUSINESS U TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO NYADDRESS OF BUSINESS ^n S MAP/PARCEL NUMBER (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has be - inf -Feed of y rmit requirements that pertain to this type of business.
Authoriz68 Signature*
COMMENTS:
• r
2. BOARD OF HEALTH
This individual h inform r i dements that pertain to this type of business.
Authorized S atur MUST COMIKY WITH ALL
e** :NA7ARDOUSMATERIALS.REGULATIONS
COMMENTS: -
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS-
/ I�
TOWN OF BARNSTABLE Date /I
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: q -�e Vie,
BUSINESS LOCATION: 0 C A 4-er S6 INVENTORY
MAILING ADDRESS: 17.i Ca mn SD I I L1 Vjec, "N crrno( 'm TOTAL AMOUNT:
TELEPHONE NUMBER: SO g q(3 S N 0 ci
CONTACT PERSON: i2ebor,A A-e '
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: �Gc,, Y4(YI
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
LV
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts(Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains,dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other,products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents 5
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App an s ignature Staff's Initials
r
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main.St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law.
DATE: Fill in please:
�,;�,,: ;;•,t;;�;G,aqu3��'y APPLICANT'S YOUR NAME S: L'
YOUR HOME ADDRESS:
c7
USINESS
B
.c,'_=3;��J,lutZ.�t,y,!i-'• .tLm;'•L'`"-;';.-I CZ. •'.fL�. .'�. I/I'j ��- CuL 3.�?
TELEPHONE # Home Telephone Number D-Y 4"26, 2-1 Z
1 P+ 17�i'7 L•�%�EiRJ li��t>k�
j( NAME OF CORPORATION:'—r i S
NAME OF-NEW BUSINESS ' TYPE OF BUSINESS I
!WL
I IS THIS A HOME OCCUPATION? YES ND
! ADDRESS OF BUSINESS. . ✓ s C AP/PARCEL NUMBER;~
� ) [Assessing)
I When starting a new business there are several things you m.ust do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S 0 FICE
This individual has been inf ,m any per it merits that pertain to this type of business.
Authorize signature**
COMMENTS:
2..BOARD OF HEALTH
This individual has been informed of mit requirements that pertain to this type of business.
Author' Sig ature**
COMMENTS:
3. CONSUMER AFFAIRS [LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS-YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: ,% 3 i Co ��GPP Fill in please:
APPLICANT'S YOUR NAME/S:
>: BUSINESS YOUR HOME ADDRESS: 61
-3007 od StCGwbe('M
_....._:_p %2_4049.9 SS i3 rN 03(o 0�
TELEPHONE # Home Telephone Number SOFc- Co�-tS' Q8�5
NAME OF CORPORATION:
NAME OF NEW BUSINESS CU5+0'y\ C.on ide'f)Ce, S\y t TYPE OF BUSINESS Or�rw� Qf cnG1 S2fvtc
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS -70 en+-e<' 54,l�•e_A- I•± r Cr*16 MO 0,)W+ MAP/PARCEL NUMBER s'Z l (Assessing)
irs�de ore :rnsyMe, SGlor \
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMThb
R'S OFFIC
This individu of rn re, of y rmi q irement that pertain to this type of business.
zed Signat e* G�
COMMENTS-Lb — -/-)1�4- ,N_4A 4L C/1)
2. BOARD OF HEALTH
This individual has been inform of rmit r quire ents that pertain to this type of business.
Authorized gnature*
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: - -
YOU WISH TO OPEN A BUSINESS?
For Your Information: 'Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office,.1 st FI-, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
y �up DATE: Fill in please:
1 sFa JV APPLICANT'S YOUR NAME/S: �1 kr(t b (� -,r ►^elk
BUSINESS YOUR HOME ADDRESS: b i+ (' yt
TELEPHONE # Home Telephone Number -
NAME QF CORPORATION y
NAME OF NEW BUSINESS C ) _ TYPE OF'gUSINESS �=i � e cc (x ►1
IS THIS A HOMEIOCC(JPAjI(7N? YES : NO cLl
;ADOESSDO%BUSfI�ISS� ` c� :MAP%PARCELNUIVI®ER `J (Assessing):
�.!
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual ha$be a' orb.Aof the permit requirements that pertain to this type of business.
uthori i I
COMMENTS: I�1 �5 (�� l q'J�U Y�'"�✓� r�l
S. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$hO,00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
IU12!rl o) I
DATE: Fill in please:
w
APPLICANT'S YOUR NAME/S: IS
`=t BUSINESS YQUR HOME ADDRESS: i U \ GU CJ COco
SLo7 3��Zn ►I�tGI dc�1'c ', I 1 E1� ri° e 2
TELEPHONE # Home Telephone Number U W 3(9 7 5
NAME-OF CORPORATION: # `
NAME OF NEW BUSINES I ri n rc TYPE OF BUSINESS S 6 n ' CA
IS THIS A HOME OCCUPATION? YES NO_,9—
ADORESS OF BUSINESS r h� � �� MAP/PARCEL NUMBER 2 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of tlXe Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMI IONE 'S OFFI
This individual as e Inform f y rmi requirem at pertain to this type of business.
ut ized Signature
COMMENTS: bIm
2. BOARD OF HEALTH
This individual has beenppArrne�of the permit requirements that pertain to this type of business.
VV A
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LI NSIN UTHORITY)
This individual has b¢ef infor e t licensing requirements that pertain to this type of business.
Authorized Signatur A Lt�Le
COMMENTS: 0
JL
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L. - it does not give you permission to operate_] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: _ Fill in please:
APPLICANT'S YOUR NAME/S.`
-' BUSINESS YOUR HOME AD RESS: O
TELEPHONE # Home Telephone Number
NAME OF CORPORATION:
NAME OF NEW.BUSINESS 1 \ TYPE OF BUSINESS 1 G S
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS O MAP/PARCEL NUMBER 15 [Assessing]
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth
Rd. & Main Street] .to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual has.,heef1ferY4ioofthe permit requirements that pertain to this type of business,
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY]
This individual has been informed of.the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
1
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(coat$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which
you must do by M.G.L.-it does not give you permission to,operate.). Business Certificates are available at the Town Clerk's Office, I FL.,357
Main Street, Hyannis,MA 02601 (Town Hall)
�,. DATE:C�l 7 U `
r Fill in please:
APPLICANT'S YOUR NAME: /�O Y //
BUSINESS YO R HOME ADDRESS:_ < .�tt ri# L ,
6 0 -9 775 A os _p le�i'�*L-�_r 1 Z.6�t.c�
TELEPHONE # Home Telephone Number 5_68 ZT"7`7 5-50
NAME OF NEW BUSINES - �Ct'(Z ; TYPE OF.BUSINESS'✓} t/`1 n7 F Ta2�L .
IS THIS'A HOME OCOUpA nol\1? _;YES
Hal you been given approval from the building.�Iivision. -YES, NO
ADDRESS OF BUSINESS � /�1 Ni4 N4� S MAP/'PAROEI=:NUMQERWhen'starting a new business.there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining,the information you may need. You MUST GO TO 200 Main St.---(oorner of Yarmouth
Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSI�IERIS OF ICE
This individual h s e n i�rfo d o y permit requirements that pertain to this type of business.
t. A
hori ed Si ure
COMMENTS: jr;:Q,7
2. BOARD OF HEALTH
This individual h een infor d o the p r i6 requir ments that pertain to this type of business.
AuthorizedS' 11
ature**
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate. -ErOiress Certificates are available at the Town Clerk's Office, 1 FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATES 1�� �� Fill in please: ,
av
APPLICANT'S YOURNAME/S: -�ud\� 5arno�n �h'►11�g5 _
BUSINESS YOUR HOME ADDRESS:. -3ZD St- VYi1+ 6 `�
TELEPHONE # ome Telephone Numbfr
NAME OF CORPORATION:
NAME OF NEW BUSINESS 1 y\e Nr ' TYPE OF BUSINESS 5b(in are
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS 'itU nfi r tQ 4 Jq j so v MAP/PARCEL NUMBER - (Assessing)
When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information ybu may need. You MUST GO TO 200 Main St. - c rner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and Ifrenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual h informed-qf th it requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has beery informed of the licensing requirements that Irertain to this type of business.
Authorized Signature**
COMMENTS:
Date:
TOXIC AND HAZARDOUS MA RIALS REGISTRATION FORM
NAMEOFBUSINESS:�J�� / //I/�1�/7 /Ma :e7-
BUSINESS LOCATION: � ®l// _r__
MAILINGADDRESS: S� /�l /i'� jls'��,��f �� ,�} pf� Mail To:
TELEPHONE NUMBER: -�21VLf,3 Board of Health
��I
CONTACT PERSON: /flL' jt�° Town of Barnstable_ P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOFBUSINESS: lWeillC-7 jv!"/ 4-
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO [�-'
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ;a
NAME OF BUSINESS: C&2 6a D STM)I4, V Mail To:
BUSINESS LOCATION: 70 CiWn, ,e 4 Board of Health
MAILING ADDRESS: Cant XL) /y��.fra/_S &j`4 f4Town of Barnstable
� oa�y� P.O. Box 534
TELEPHONE NUMBER: �6A_T 7� ��"S.-3 l/�76ZA� Hyannis, MA 02601
CONTACT PERSON: �rJ=
EMERGENCY CONTACT TELEPHONE NUMBER:
I
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES r"' NO /00 L0-S;
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS: ,7L> G�.t/T�.� sr
TELEPHONE: _1-0tF Z7,f- �S:573 y''•9J0"y"I
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers _ Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's -�
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)_
Floor & furniture. strippers Any other products with 'Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4. Manufacturers
COMPANY (see"Orders") 5. Retail Stores
6.Fuel Suppliers
ADDRESS '1 f C2- Class: 7. Miscellaneous
�.�n►S QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATESUnderiTT'ound Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSALIRECLAMATION REMARKS:
3,. Sanitary Sewage later Supply
Town Sewer VPublic Ny L
O On-site OPrivate
3.Indoor Floor Drains YES N0
O Holding tank:MDC
O Catch basin/Dry wellSS� � l
O On-site system � `� N V
4. Outdoor Surface drains:YES N0 ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
'Name of Hauler
Destination Waste Product
YES N0
1.
2.
Person(s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4. an
COMPANY �'a � �J O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 7 4.� '4 Class: ;;:,� 7.Miscellaneous
101
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MAT IALS �o; :
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneou
DISPOSAL(RECLAMATION REMARKS:
1. anitary Sewage 2.Water Supply 9 ! tf_x
Town Sewer Public
O On-site OPrivate
3.Indoor Floor Drains YES NO
O Holding tank:MDC_
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
t
YES NO
2.
nsp
Person(s rviewed ector / Date
I
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
nters
BOARD OF HEALTH (l satisfactory 3.2.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY -Si L .ri S (see"Orders") 5.Retail Stores �
6.Fuel Suppliers
ADDRESS � Class: 7 7.Miscellaneous
IVILl"n;C QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS 7#&
7177
IN OUT IN OUllons Age Test
Fuels:
Gasoline,Jet Fuel(A)
11
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
Adko-sm-e l
/D o a
DISPOSAIJRECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
Town Sewer Wublic
On-site O Private
3. Indoor Floor Drains YES NOX
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
1 YES INO
.
2.
Person (036terviewed. Inspe for / Date